TY - JOUR
T1 - Clinical outcome after surgical correction of mitral regurgitation due to papillary muscle rupture
AU - Russo, Antonio
AU - Suri, Rakesh M.
AU - Grigioni, Francesco
AU - Roger, Véronique L.
AU - Oh, Jae K.
AU - Mahoney, Douglas W.
AU - Schaff, Hartzell V.
AU - Enriquez-Sarano, Maurice
PY - 2008/10/7
Y1 - 2008/10/7
N2 - Background - Papillary muscle rupture (PMR) is an infrequent but catastrophic complication of acute myocardial infarction (MI). Although always considered, surgical treatment is often denied because of high operative mortality. Moreover, the effects of surgery for PMR on long-term outcome, particularly compared with expected outcome after MI, are undefined. Methods and Results - Fifty-four consecutive patients (age, 70±8 years; 74% male) underwent mitral surgery for post-Mi PMR from January 1980 through December 2000. Severe presentation (cardiogenic shock, pulmonary edema, or cardiac arrest) was noted in 91% preoperatively. Performance of coronary artery bypass graft was associated with lower operative mortality (odds ratio, 0.18; 95% CI, 0.04 to 0.83; P=0.011), whereas there was a trend for lower mortality after surgery after 1990 (odds ratio, 0.28; 95% CI, 0.06 to 1.3). Thus, operative mortality (overall, 18.5%) decreased from 67% up to 1990 without coronary artery bypass graft to 8.7% after 1990 with coronary artery bypass graft. Overall 5-year survival was 65±7%, and survival free of congestive heart failure was 52±7%. Five-year survival of 30-day operative survivors was 79±4%, identical (P=0.24) to that of matched controls with MI (similar age, sex, ejection fraction, MI location, and MI year). Survival free of congestive heart failure was similar in PMR cases and MI controls (10-year survival, 28±8% versus 36±6%; P=0.46). Conclusions - Surgery for post-MI PMR involves a notable operative mortality, but there are recent trends for lower operative risk, particularly with associated coronary artery bypass graft. Long term after surgery, outcome is restored to that of similar MI without PMR. These encouraging observations emphasize the importance of prompt diagnosis and aggressive therapeutic approach for patients incurring PMR after MI.
AB - Background - Papillary muscle rupture (PMR) is an infrequent but catastrophic complication of acute myocardial infarction (MI). Although always considered, surgical treatment is often denied because of high operative mortality. Moreover, the effects of surgery for PMR on long-term outcome, particularly compared with expected outcome after MI, are undefined. Methods and Results - Fifty-four consecutive patients (age, 70±8 years; 74% male) underwent mitral surgery for post-Mi PMR from January 1980 through December 2000. Severe presentation (cardiogenic shock, pulmonary edema, or cardiac arrest) was noted in 91% preoperatively. Performance of coronary artery bypass graft was associated with lower operative mortality (odds ratio, 0.18; 95% CI, 0.04 to 0.83; P=0.011), whereas there was a trend for lower mortality after surgery after 1990 (odds ratio, 0.28; 95% CI, 0.06 to 1.3). Thus, operative mortality (overall, 18.5%) decreased from 67% up to 1990 without coronary artery bypass graft to 8.7% after 1990 with coronary artery bypass graft. Overall 5-year survival was 65±7%, and survival free of congestive heart failure was 52±7%. Five-year survival of 30-day operative survivors was 79±4%, identical (P=0.24) to that of matched controls with MI (similar age, sex, ejection fraction, MI location, and MI year). Survival free of congestive heart failure was similar in PMR cases and MI controls (10-year survival, 28±8% versus 36±6%; P=0.46). Conclusions - Surgery for post-MI PMR involves a notable operative mortality, but there are recent trends for lower operative risk, particularly with associated coronary artery bypass graft. Long term after surgery, outcome is restored to that of similar MI without PMR. These encouraging observations emphasize the importance of prompt diagnosis and aggressive therapeutic approach for patients incurring PMR after MI.
KW - Coronary disease
KW - Heart failure
KW - Mitral valve
KW - Myocardial infarction
KW - Surgery
KW - Survival
KW - Valves
UR - http://www.scopus.com/inward/record.url?scp=55249108200&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=55249108200&partnerID=8YFLogxK
U2 - 10.1161/CIRCULATIONAHA.107.747949
DO - 10.1161/CIRCULATIONAHA.107.747949
M3 - Article
C2 - 18809799
AN - SCOPUS:55249108200
SN - 0009-7322
VL - 118
SP - 1528
EP - 1534
JO - Circulation
JF - Circulation
IS - 15
ER -